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To reduce delayed transfers of care in hospital, a new perspective piece argues Australia should look to policy decisions implemented in the UK.
A perspective piece published in The Medical Journal of Australia explores how the coronavirus disease 2019 (COVID-19) pandemic increased congestion to the already overcrowded emergency departments of Australian hospitals.
Professor Tarun Bastiampillai, Victorian Healthcare Association deputy chief executive Juan Paolo Legaspi, and senior policy officer Benedict Rogers wrote that this congestion led to widespread workforce shortages, increased ambulance ramping, emergency departments beyond capacity and a shortage of available beds.
Their perspective piece argues the congestion could be alleviated by addressing the problem of delayed transfers of care; this refers to patients in hospital care who are medically able to be discharged, but are unable to leave due to non-clinical reasons, such as a lack of available residential aged care, home care or disability care.
“We felt that the current debate on hospital congestion required a fundamental whole-of-government discussion on understanding the impact of delayed transfers of care (exit block) on hospital congestion, Professor Bastiampillai and Mr Legaspi told InSight+.
“There could be learnings from other countries that could help better inform the appropriate Australian policy response.”
Looking to the United Kingdom
They looked to the United Kingdom for examples of how Australia could better manage delayed transfers of care.
A policy introduced in in the UK in 2003 required local authorities to reimburse the National Health Service (NHS) for each day an acute patient’s discharge was delayed when social services were solely responsible for that delay.
This idea originally stemmed from the 2002 Wanless report, which highlighted Sweden’s success in implementing a similar scheme.
Between 2017 and 2020, after the implementation of this policy in the UK, the number of bed-days from delayed transfers of care decreased by 22%.
In order to successfully implement a similar policy here, the article authors believe that Australia will first need to capture comprehensive national data in order to ensure the UK model is properly adapted to suit Australia’s unique health care landscape.
“The problem of delayed transfers of care has been well known by policy makers and clinicians for several years,” they said.
“But the lack of objective and transparent data for this patient population has significantly contributed to a strategic and policy gap in whole-of-system health care planning.
“We would like to see a national standardised data collection system to understand and monitor this issue.”
Professor Bastiampillai and Mr Legaspi told InSight+ the following steps could be taken to begin collating the necessary data and implementing policy changes:
- develop an integrated whole-of-government view of these interdependent systems of care;
- introduce a national monthly dashboard of delayed transfers of care by state, region and hospital site, which is available to all levels of government;
- analyse these trends over time and identify reasons for regional and hospital variance in both proportion of delayed transfers of care and their accompanying occupied bed-days (acute and non-acute); and
- identify appropriate funding arrangements for delayed transfers of care between the federal and state governments.
Improving data
Their call for standardised data has been supported by the Australian Medical Association (AMA) president Professor Stephen Robson, who pointed to a recent AMA report on Hospital Exit Block.
This report found only three of the 201 Australian public hospitals were delivering care within recommended timeframe, down from 15 in 2021.
“The first thing we need to address with [hospital congestion] is understanding who and where these patients are, and why there are delays in accessing community care,” Professor Robson told InSight+.
“Once we have that data, the federal and state governments can work together and align their policies to improve the system.”
Improving data-enabled care is also a key consideration in a Productivity Commission report Advancing prosperity, released on Friday 17 March 2023.
The Productivity Commission recommends that the government should “[accelerate and scale up] long-term co-operative funding mechanisms that align the incentives of primary and hospital providers to avoid costly hospital admissions and support integrated care”.
Professor Bastiampillai and Mr Legaspi believe their proposal supports this vision and will align the incentives of multiple care providers to improve patient experience and overall system efficiency.
“Policy makers need to take a holistic perspective on the care economy,” they said.
“There needs to be an integrated whole-of-government view of these interdependent systems of care. This can only effectively be conducted if patient journeys across these systems of care are better understood and recorded.”
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